Test 22 - IM

Question 1

How do you diagnose CLL?

Answer 1

Flow cytometry : allows to count and sort cells in order to prove that clonality of abnormal lymphocytes - thus cancer

Question 2

Signs of CLL

Answer 2

1. extremely elevated WBC count 2. majority lymphocytes on peripheral smear 3. smudge cells on smear

Question 3

Symptoms of CLL

Answer 3

Elderly patients lymphadenopathy or often asymptomatic

Question 4

What is hyperdynamic circulation?

Answer 4

abnormally increased circulatory volume

Question 5

Why do hyperthryoid patients become hyperdynamic?

Answer 5

The cardiac effects of hyperthyroidism commonly cause increased preload with low systemic vascular resistance, a high heart rate, and increased cardiac muscle oxygen consumption. In the short term hyperthyroidism these effects result in an increased heart rate and high cardiac output.

This causes secondary HTN

Question 6

Histology of basal cell carcinoma?

Answer 6

Invasive clusters of spindle cells surrounded by pallisaded basal cells.

Question 7

Histology of squamous cell carcinoma?

Answer 7

Invasive chords of squamous cell with keratin pearls.

Question 8

Presentation of squamous cell carcinoma?

Answer 8

solitary ulcer that is not healing well in an area exposed to the sun often (ie. vermillion border of the lower lip)

Question 9

Histology of apthae (canker sores)?

Answer 9

Shallow fibrin coated squamous cells with keratin pearls

Question 10

How do you diagnose Guillian-Barre?

Answer 10

Clinical assesment PLUS

Lumbar puncture with increased protein and WBCs in CSF

Electromyogram

Question 11

Treament of Guillain-Barre?

Answer 11

1. Supportive care (monitoring autonomic and respiratory function)
2. IVIG or plasmaphoresis (both equally good)

Question 12

Clinical features of aortic regurgitation?

Answer 12

1. Diastolic decrescendo murmor
2. Widened pulse pressure
3. Collapsing/ waterhammer pulse
4. Signs of heart failure

Question 13

Common causes of aortic regurgitation?

Answer 13

aortic root dilation

post inflammatory (rheumatic heart disease, endocarditis)

congenital bicuspid aortic valvue

Question 14

Pathophysiology of aortic regurgitation?

Answer 14

1. Backflow from aorta to LV leads to increased left ventricular end diastolic volume (LVEDV)
2. Increased LVEDV results in compensatory LV hypertrophy
3. Eventually, increased LVEDV overstreches the heart, leading to decreased stroke volume and cardiac output.
4. Increased LVEDV leads to pulmonary congestion

Question 15

Why does the left lateral decubitis position bother patients with aortic regurg?

Answer 15

Brings enlarged left ventricle closer to the chest wall and causes a pounding sensation and increased awareness of the heartbeat

Question 16

How do you calculate anion gap?

Answer 16

AG = Na - (HCO3+ Cl)

Question 17

What is the normal anion gap?

Answer 17

6-12 mEq/L

Question 18

Why is anion gap useful?

Answer 18

It proves that there are non-chloride acids in the blood that are causing the metabolic acidosis

Question 19

What are some of the most likely causes of an increased anion gap?

Answer 19

1. Lactic acidosis
2. Ketoacidosis
3. Methanol ingestion
4. Ethylene glycol ingestion

Question 20

Recurrent pneumonias in the same anatomical region suggest what?

Answer 20

Bronchial obstruction

Question 21

What do you do before you get a bronchoscopy?

Answer 21

Get a CT of the lungs needed to visualize any parenchymal abnormalities and to rule out lung cancer.